1. Understand nurse aide skills needed to promote skin integrity. Unit B Resident Care Skills Essential Standard NA5.00 Understand nurse aide’s role in providing residents’ hygiene, grooming, and skin care. Indicator 5.02 Understand nurse aide skills needed to promote skin integrity. 15.02Nursing Fundamentals 7243

2. 2 POSITIONING 5.02

3. Nursing Fundamentals 72433 POSITIONINGPurposes: Assist with examinationsAssist with examinations Assist with proceduresAssist with procedures Prevent pressure on skin for prolonged periods of timePrevent pressure on skin for prolonged periods of time 5.02

4. Nursing Fundamentals 72434 POSITIONS Dorsal recumbent position flat on back knees slightly separated and flexed feet flat on bed http://www.wisc- online.com/objects/ViewObject.aspx?ID=ME A1604 5.02

5. Nursing Fundamentals 72435 POSITIONS Horizontal recumbent position – supine flat on back legs slightly separated and extended http://www.wisc- online.com/objects/ViewObject.aspx?ID=M EA1604 5.02

6. Nursing Fundamentals 72436 POSITIONS Prone position flat on abdomen with head turned to side arms at sides or flexed on either side of head http://www.wisc- online.com/objects/ViewObject.aspx?ID=M EA1604 5.02

7. Nursing Fundamentals 72437 POSITIONS Side lying position positioned on either side head in straight line with spine pillows used to support head, back, arm, and leg http://www.wisc- online.com/objects/ViewObject.aspx?ID=MEA1604 5.02

8. Nursing Fundamentals 72438 POSITIONS Lateral position positioned on either side bottom arm extended behind back, top arm flexed in front of body top leg slightly flexed http://www.wisc- online.com/objects/ViewObject.aspx?ID=MEA1604 5.02

9. Nursing Fundamentals 72439 POSITIONS 30  Lateral Reclined Position hips rotated 30 degrees pillow between knees pillow under arm for comfort and to relieve pressure on elbow pressure relieved from sacrum and http://www.wisc- online.com/objects/ViewObject.aspx?ID=MEA1604 hip 5.02

10. Nursing Fundamentals 724310 POSITIONS Fowler’s position sitting position in bed with head elevated at 45-60 degree angle. knees slightly flexed position causes pressure on sacrum and buttocks http://www.wisc- online.com/objects/ViewObject.aspx?ID=MEA1604 5.02

11. Nursing Fundamentals 724311 POSITIONS Sim's position positioned on LEFT side left arm extended behind body right arm flexed in front of body right leg flexed toward abdomen used for enema administration http://www.wisc- online.com/objects/ViewObject.aspx?ID=MEA1604 5.02

12. Nursing Fundamentals 724312 POSITIONS Sim's position Best position for enemas 5.02

13. Nursing Fundamentals 724313 TURNING POSITIONING LIFTING MOVING 5.02

14. Nursing Fundamentals 724314 Moving, Turning, Positioning And Lifting Good body mechanics necessary  Prevents injury to resident  Protects nurse aide from injury  Good body alignment Promotes comfort for resident 5.02

15. Nursing Fundamentals 724315 Moving, Turning, Positioning And Lifting Safety major considerations  Get help if needed  Receive directions from supervisor regarding any restrictions for positioning or movement 5.02

16. Nursing Fundamentals 724316 Moving, Turning, Positioning And Lifting Safety major considerations  Protect and secure any special equipment being used by the resident prior to movement (e.g., drainage tubes).  Elevate bed to comfortable working level 5.02

17. Nursing Fundamentals 724317 Moving, Turning, Positioning And Lifting Safety major considerations Protect skin from friction  roll when possible  lift with assistance  prevent sliding  use turning sheet 5.02

18. Nursing Fundamentals 724318 Moving, Turning, Positioning And Lifting Use postural supports as directed:  Rolled blankets  Pillows  Rolled towels  Footboards  Bed cradles 5.02

19. Nursing Fundamentals 724319 Moving, Turning, Positioning And Lifting Reposition at least every two hours or as directed  Eliminates pressure on bony areas  Provides comfort  Exercises muscles  Moves joints  Stimulates circulation 5.02

20. Nursing Fundamentals 724320 Moving, Turning, Positioning And Lifting Coordinate lifting and moving  Move on a certain count, usually count of three  Gain cooperation of resident  Have residents help themselves as much as possible 5.02

21. Nursing Fundamentals 724321 Moving, Turning, Positioning And Lifting Coordinate lifting and moving (continued)  Use transfer belt (gait belt) when appropriate  When in doubt, always ask for assistance from co-workers 5.02

22. Nursing Fundamentals 724322 Repositioning Resident In Chair Or Wheelchair 5.02

23. Nursing Fundamentals 724323 Repositioning Resident In Chair Or Wheelchair Reasons for changing position every two hours or as directed  Promotes comfort  Reduces pressure  Increases circulation  Exercises joints  Promotes muscle tone 5.02

24. Nursing Fundamentals 724324 Repositioning Resident In Chair Or Wheelchair Body kept in good alignment with head in straight line with spine Plastic or vinyl surface of chair covered, with use of pressure- relieving cushion preferred Pillows or soft blankets used for support 5.02

25. Nursing Fundamentals 724325 Repositioning Resident In Chair Or Wheelchair Feet REST on floor or footrest of wheelchair 5.02

26. Nursing Fundamentals 724326 Repositioning Resident In Chair Or Wheelchair Hips positioned well back in chair 5.02

27. Nursing Fundamentals 724327 Repositioning Resident In Chair Or Wheelchair Weight shifting utilized in between repositioning 5.02

28. Nursing Fundamentals 724328 Covering applied to wound or injured body part where slight risk of infection or re-injuryCovering applied to wound or injured body part where slight risk of infection or re-injury Materials come in various types and sizes:Materials come in various types and sizes: –Gauze pads –Band-aids –Thick compresses APPLYING NON-STERILE DRESSINGS 5.02

29. Nursing Fundamentals 724329 Requires physician’s order for type of therapy and length of time for applicationRequires physician’s order for type of therapy and length of time for application WARM AND COLD THERAPY 5.02

30. Nursing Fundamentals 724330 Purposes and EffectsPurposes and Effects –WARMTH: dilates blood vessels increased blood supply to areaincreased blood supply to area blood brings oxygen & nutrients for healingblood brings oxygen & nutrients for healing fluids are absorbedfluids are absorbed muscles relaxmuscles relax pain relievedpain relieved WARM AND COLD THERAPY 5.02

31. Nursing Fundamentals 724331 Purposes and EffectsPurposes and Effects –COLD: constricts blood vessels decreased blood supply to areadecreased blood supply to area prevents swellingprevents swelling controls bleedingcontrols bleeding numbs skin, reducing painnumbs skin, reducing pain reduces body temperaturereduces body temperature WARM AND COLD THERAPY 5.02

32. Nursing Fundamentals 724332 Dry cold - water does not touch skinDry cold - water does not touch skin –ice bags –ice caps –ice collars –disposable cold pack TYPES OF WARM AND COLD THERAPY 5.02

33. Nursing Fundamentals 724333 Moist cold - water touches skinMoist cold - water touches skin –compresses – localized application –soaks - body part immersed in water –cool sponge bath TYPES OF WARM AND COLD THERAPY 5.02

34. Nursing Fundamentals 724334 Dry warmth – pads with circulating warm waterDry warmth – pads with circulating warm water Moist warmthMoist warmth –compresses –soaks –sitz bath TYPES OF WARM AND COLD THERAPY 5.02

35. Nursing Fundamentals 724335 –Use bath thermometer to measure the temperature of moist heat solutions. –Do not operate equipment you have not been trained to use. –Temperature never over 105° F. Check skin frequently and report any signs of complications. GUIDELINES FOR WARM THERAPY 5.02

36. Nursing Fundamentals 724336 –Apply ice caps with metal or plastic lids away from skin –Cover ice caps/bags/collars prior to application –Check skin frequently and report any signs of complications –Never leave in place longer than directed by supervisor GUIDELINES FOR COLD THERAPY 5.02

37. The Bottom Line 5.02Nursing Fundamentals 724337 Skin is the body’s first line of defense against disease. Maintain the integrity of the skin.

38. Understand nurse aide’s role in promoting skin integrity. 38  END  5.02 Nursing Fundamentals 7243